LAUSR

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various cardiac manifestations of the COVID-19 virus have been reported since early 2020, including a range of arrhythmias, but to our knowledge, only 2 case reports exist describing new bradycardia in patients with COVID-19 infection. We aimed to analyze the association between sinus bradycardia and severity of covid-19 infection, including survival outcomes. METHODS: A retrospective analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on 3 consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Remdesivir, Albuterol, and Lasix), and ICU admission. The severity of COVID-19 infection was graded by the need for ICU admission vs. no ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, as 120 patients with prior heart block were excluded. 508 patients (33.1%) required ICU admission due to severe hypoxia, 708 patients (46.2%) had at least one episode of significant bradycardia. Our sample population had an inpatient all-cause mortality of 18.1%. After adjusting for confounding variables, it was seen that patients with incident bradycardia on 3 consecutive days were more likely to require ICU admission than patients without these bradycardia events (Odds Ratio 1.58, p=0.001). There was no significant association of bradycardia with survival to hospital discharge (p=0.761). It was also seen in a sub-analysis that tachycardia on day-3 is statistically significantly associated with 7-day mortality, such that patients with tachycardia on day 3 had 2.9 (p<0.001) times the odds of 7-day mortality compared to those with normal heart rate. We also tested the overall significance of pulse rate at day-0, day 3, day 7, and persistent bradycardia and found that pulse at day 3 was a statistically significant predictor of 7-day mortality (p=0.001). CONCLUSIONS: Our findings suggest a possible correlation between bradycardia and the severity of COVID-19 symptoms;more severe COVID-19 cases were associated with a higher incidence of new bradycardia events. Transient sinus bradycardia can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, but the exact etiology is still unknown. Bradycardia might be a warning sign of possible acute worsening of symptoms and should be monitored closely. Further studies are warranted to confirm these findings. CLINICAL IMPLICATIONS: Transient sinus bradycardia is possibly associated with a higher likelihood of ICU admission due to the severity of COVID-19 symptoms, and these patients should be monitored closely. DISCLOSURES: No relevant relationships by Firas Abdulmajeed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response